More on harm reduction at
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‘We need to be present,
consistently – not just from
nine to five in an office, but
at 6am in the car parks and at
10pm out with the working girls...
These are people’s lives!’
provide, like access to a nutritionist, wound care specialist or dentist. But what
the service really craves is ‘to reduce pressure on staff, invest in quality training
and nurture specialisms’.
‘One of the heartbreaking things to watch over the last few years is how so
many of my colleagues with a love and speciality for harm reduction have moved
into other areas of the care sector, or even out of it entirely. Why? Because it’s not
worth the heartache,’ she says. ‘You either have to leave because it’s too much, or
suck up your pride and principles and get on with the work at hand.’
‘Most importantly,’ she says, ‘we need to really take a step back and reduce the
threshold for those accessing support – it can’t be that we turn away the chaotic,
dependent injecting drug user because they are ten minutes late for their
appointment. We need to be present, consistently – not just from nine to five in
an office, but at 6am in the car parks and at 10pm out with the working girls.’
my thinks that introducing key performance indicators (KPIs) for
harm reduction might be the way to regain energy and focus, and
redress the attitude that ‘no one really cares about what we do or
don’t do on the front end’. Having ‘60 clients on your caseload and
a mountain of admin on your desk’ translates to telling the client
‘take your script and I will see you in two weeks’, instead of giving
them the time and energy required for a meaningful working relationship.
‘We underestimate the power that just sitting down and having a cuppa and
a chat, with no expectations, can have. We need time and we need patience, and
unfortunately there is no pot of funding for that,’ she says, adding: ‘I regularly sit
in team meetings in which discharge stats are sniffed out like dogs with a bone.
These are people’s lives!’
Mark is also weary of the attitude that ‘NSP cover is something that can be
delivered by anyone, often admin staff’. He believes that the initiative must be
taken by treatment providers, in the same way that naloxone distribution has
(eventually) been embraced. Just three years ago he remembers that a senior
man ager in one of the larger organisations was instructing members of staff that
they ‘must not talk about naloxone as we are not a campaigning organisation’.
Many organisations are still silent about issues such as drug consumption
rooms (DCRs) and heroin-assisted therapy, perhaps taking their lead from the
government’s drug strategy, which (while acknowledging that we should protect
society’s most vulnerable) only fleetingly mentions harm reduction and ignores
the importance of outreach.
‘The providers of treatment really need to start to use the language of harm
reduction and be clear about a commitment to those approaches, rather than
continuing with a culture of harm reduction by stealth,’ says Mark. ‘If they don’t
believe that they should do everything possible to campaign for initiatives and
interventions that can reduce the numbers of deaths among their service users,
then we are in an impossible situation.’ DDN
A
using lower-threshold pharmacy services, this is seen as a further reason to keep
downgrading this essential service.
Amy’s colleagues in another service from the same provider have told her
about the ‘no bin, no pin’ policy there t o encourage returns, getting rid of pre-
injection swabs ‘for good old soap and water – great! Unless of course you don’t
have access to such facilities!’, and ceasing the distribution of water ampoules
because of unfathomable ‘concerns around legalities’.
According to Amy, a little investment in her needle exchange would go a
long way. There are the material items that could be bought with more money –
the BBV testing kits and homeless packs; and the specific services they could
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December/January 2018 | drinkanddrugsnews | 7